Podcast
Questions and Answers
Which structure is essential for the exocrine function of the pancreas?
Which structure is essential for the exocrine function of the pancreas?
- Islets of Langerhans
- Duct of Wirsung (correct)
- Celiac axis
- Common bile duct
What is the anatomical structure primarily affected in 95% of pancreatic tumors?
What is the anatomical structure primarily affected in 95% of pancreatic tumors?
- Stomach
- Tail of pancreas
- Head of pancreas (correct)
- Body of pancreas
What is the main purpose of a pylorus preserving pancreaticoduodenectomy?
What is the main purpose of a pylorus preserving pancreaticoduodenectomy?
- To remove the entire stomach
- To prevent pancreatic enzyme secretion
- To preserve the pyloric sphincter and maintain gastrointestinal continuity (correct)
- To improve blood supply to the pancreas
Which of the following is NOT a component removed during a laparoscopic Whipple resection?
Which of the following is NOT a component removed during a laparoscopic Whipple resection?
Which pancreatic cancer's symptom is likely due to bile duct obstruction?
Which pancreatic cancer's symptom is likely due to bile duct obstruction?
What is the primary function of the liver related to blood glucose levels?
What is the primary function of the liver related to blood glucose levels?
Which ligaments are involved in a splenectomy?
Which ligaments are involved in a splenectomy?
Which vessels are involved in the hepatic blood supply?
Which vessels are involved in the hepatic blood supply?
What is the purpose of hepatic resection?
What is the purpose of hepatic resection?
What is contained within the portal triad of each liver lobe?
What is contained within the portal triad of each liver lobe?
What is the average storage capacity of the gallbladder?
What is the average storage capacity of the gallbladder?
Which artery supplies blood to the gallbladder?
Which artery supplies blood to the gallbladder?
What is the main purpose of the Endoscopic Retrograde Cholangeopancreatography (ERCP) procedure?
What is the main purpose of the Endoscopic Retrograde Cholangeopancreatography (ERCP) procedure?
What type of procedure is a choledocholithotomy?
What type of procedure is a choledocholithotomy?
Which surgical intervention is most commonly performed laparoscopically?
Which surgical intervention is most commonly performed laparoscopically?
During an ERCP, where is the scope inserted?
During an ERCP, where is the scope inserted?
What indicates the presence of gallstones during a cholangiogram?
What indicates the presence of gallstones during a cholangiogram?
What role does the scrub nurse have during blood loss preventative measures?
What role does the scrub nurse have during blood loss preventative measures?
What is the main function of the spleen?
What is the main function of the spleen?
Which type of pancreatic transplant is most common?
Which type of pancreatic transplant is most common?
What are the critical steps in performing a splenectomy?
What are the critical steps in performing a splenectomy?
Which equipment is specific to the laparoscopic approach during a splenectomy?
Which equipment is specific to the laparoscopic approach during a splenectomy?
After a successful pancreas transplant, what happens to insulin-dependent patients?
After a successful pancreas transplant, what happens to insulin-dependent patients?
What types of patients are typically candidates for a pancreas transplant?
What types of patients are typically candidates for a pancreas transplant?
What is a major consideration during a splenectomy procedure?
What is a major consideration during a splenectomy procedure?
What must be ligated in the splenic blood supply during a splenectomy?
What must be ligated in the splenic blood supply during a splenectomy?
What is the primary purpose of using the CUSA in liver transplant procedures?
What is the primary purpose of using the CUSA in liver transplant procedures?
Which of the following best describes the types of donors for liver transplants?
Which of the following best describes the types of donors for liver transplants?
What is the primary solution used to preserve donor livers for transplantation?
What is the primary solution used to preserve donor livers for transplantation?
Which type of anastomosis involves connecting the portal veins during liver transplantation?
Which type of anastomosis involves connecting the portal veins during liver transplantation?
What is the main function of the Forced-Air warming blanket during a transplant surgery?
What is the main function of the Forced-Air warming blanket during a transplant surgery?
What type of sutures are recommended for permanent vascular anastomosis during liver transplantation?
What type of sutures are recommended for permanent vascular anastomosis during liver transplantation?
What is essential to maintain during the organ donation process?
What is essential to maintain during the organ donation process?
What is the primary use for the Argon Laser in surgery?
What is the primary use for the Argon Laser in surgery?
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Study Notes
Gallbladder Anatomy and Function
- Located behind the liver, the gallbladder stores and concentrates bile, with an average capacity of 40 to 70 mL.
- Bile aids in digestion and is released into the duodenum.
- Supplied by the cystic artery, a branch of the hepatic artery.
Perioperative Nursing Considerations
- Use of general anesthesia for cholecystectomy, performed either open or laparoscopically.
- Patients are positioned supine, with measures in place for blood loss prevention, including the scrub nurse's role.
Surgical Counts
- Initial and closing counts for open cholecystectomy are major; final count is minor.
- Laparoscopic procedures have a major initial count and minor closing and final counts.
Surgical Interventions
- Common procedures:
- Gallbladder: Cholecystectomy, ERCP (Endoscopic Retrograde Cholangiopancreatography).
- Spleen: Splenectomy.
- Liver: Hepatic resection, liver transplant.
- Pancreas: Whipple procedure, pancreatic transplant.
ERCP Procedure
- ERCP is a diagnostic procedure for the biliary tract involving scope insertion from the mouth to the duodenum.
- X-ray-guided with a catheter to visualize the common bile duct and identify blockages.
Cholangiogram
- Conducted intraoperatively; involves injecting contrast dye into the cystic duct to highlight blockages.
- Choledocholithotomy is performed to remove stones from the common bile duct.
Cholecystectomy
- Indicated for chronic inflammation and cholelithiasis; 90% are performed laparoscopically.
- Key steps include incising the Triangle of Calot, ligating and dividing the cystic artery, and dissection of the gallbladder from the liver bed.
Pancreas Anatomy
- Head of the pancreas sits against the duodenum; receives its blood supply from the celiac axis and SMA.
- The pancreas has exocrine functions (secreting enzymes) and endocrine functions (insulin and glucagon secretion).
Pancreatic Cancer
- 95% of tumors arise from the head of the pancreas; 80% are ductal adenocarcinoma.
- Symptoms include jaundice due to bile duct obstruction, and the disease has a late diagnosis and poor prognosis.
Laparoscopic Whipple Resection
- Involves the removal of head of pancreas, entire duodenum, part of jejunum, distal stomach, and lower half of the common bile duct.
- Aim to reestablish continuity post-tumor removal for better quality of life.
Anastomoses in Whipple Procedure
- Involves three major connections: pancreaticojejunostomy, hepaticojejunostomy, and gastrojejunostomy.
Pancreatic Transplant
- Options include pancreas transplant alone (PTA), simultaneous pancreas-kidney transplant (SPK), or pancreas after kidney transplant (PAK).
- Aimed at preventing complications of Type 1 Diabetes, with lifelong immunosuppressants required.
Spleen Anatomy and Function
- Located in the upper left quadrant, protected by ribs; responsible for filtering blood cells and producing white blood cells.
- Blood supply from the splenic artery, draining into the portal system; both supplies must be ligated in a splenectomy.
Splenectomy Indications
- Performed due to trauma, malignant conditions, hemolytic jaundice, and splenomegaly.
Liver Anatomy and Function
- Located in the right upper quadrant; metabolizes nutrients and regulates blood glucose levels.
- Composed of lobules divided by the falciform ligament containing a portal triad.
Liver Blood Supply
- Receives arterial blood from aorta and hepatic artery, while venous blood comes from IVC and portal vein.
Hepatic Resection
- Conducted for tumor removal; involves achieving hemostasis and careful monitoring intraoperatively.
Liver Transplantation
- Involves donor liver implantation with cadaveric or living-related donors.
- Requires complex anastomosis of hepatic arteries and veins, along with biliary reconstruction.
Organ Donation
- Managed by the Trillium Gift of Life Network in Ontario.
- Types of donors include neurological determination of death (NDD) and after circulatory death (DCD).
Maintenance of Aseptic Technique
- Critical during organ donation procedures to ensure safety and prevent infection.
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